CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Payclass Filters:GR
Eligibility Filter:Not Part C
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 400 241.00 8917.00 37.00
IFSP-IFSP-INDIVIDUALIZED FAMILY SUPPORT PLAN 178 196.00 0.00 0.00
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 762 879.00 32523.00 37.00
TCM-T1017TL-TARGETED CASE MANAGEMENT 846 2870.50 105866.25 36.88
Subtotal (Total Children Is Unduplicated) 1326 4186.50 147306.25 35.19
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.00 10.62 10.62
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 10.00 163.00 16.30
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 14.00 123.62 8.83
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 15.00 160.98 10.73
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.00 87.16 21.79
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.00 54.38 54.38
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.00 84.84 28.28
EVAL-EVAL-DEVELOPMENTAL EVALUATION 5 5.00 250.00 50.00
EXIT-EXIT-TRANSITION ASSESSMENT 1 1.50 75.00 50.00
FANE-FANE-FAMILY INTERVIEW BY COMMUNITY PROVIDER 2 2.00 60.00 30.00
IPDEF-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 1 2.00 111.00 55.50
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 14.50 1087.50 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 9.50 712.50 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.00 375.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.50 412.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 17.00 943.50 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 14 14.00 722.00 51.57
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 195 289.00 21611.00 74.78
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 114 183.50 13762.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 64 81.00 5995.50 74.02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 253 368.00 20424.00 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 131 172.00 12900.00 75.00
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.00 370.00 185.00
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.00 48.50 48.50
SCREEN-T1023-INTERDISCIPLINARY SCREENING 33 33.00 1650.00 50.00
Subtotal (Total Children Is Unduplicated) 494 1253.50 82195.10 65.57
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.00 142.50 47.50
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 1.75 87.50 50.00
INTR-INTR-INTERPRETER 7 15.25 796.50 52.23
OCCT-97530-OT SESSION BY LICENSED OT 1 0.75 50.91 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.00 58.06 58.06
TRAN-TRAN-FAMILY TRANSPORTATION 68 71.00 497.10 7.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 222 10717.0 6323.15 0.59
Subtotal (Total Children Is Unduplicated) 296 10809.8 7955.72 0.74
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Total 16249.75 237457.07 14.61
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Number of Children (Unduplicated) With at Least One Service 1379
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Center 01
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 73 705.75 5035.06 5035.06
D 0 0.00 0.00 0.00
S 15 15.00 555.00 0.00
H 3 3.00 225.00 0.00
T 52 398.00 3372.50 3372.50
761 580.75 20851.00 0.00
Other 8 101.00 403.50 0.00
-------------------------------------------------
Total 912 1803.50 30442.06 8407.56
Center 02
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 705.75 5035.06 5035.06
D 0 0.00 0.00 0.00
S 0 15.00 555.00 0.00
H 0 3.00 225.00 0.00
T 21 844.75 4710.25 4710.25
101 1055.50 25139.25 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 122 2725.00 36068.06 9745.31
Center 03
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 22 857.75 7298.06 7298.06
D 0 0.00 0.00 0.00
S 0 15.00 555.00 0.00
H 0 3.00 225.00 0.00
T 359 1267.50 24519.63 24519.63
0 1055.50 25139.25 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 381 3299.75 58140.44 31817.69
Center 04
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 857.75 7298.06 7298.06
D 0 0.00 0.00 0.00
S 0 15.00 555.00 0.00
H 0 3.00 225.00 0.00
T 0 1267.50 24519.63 24519.63
526 1586.25 43653.25 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 526 3830.50 76654.44 31817.69
Center 05
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 29 1178.25 8663.81 8663.81
D 0 0.00 0.00 0.00
S 0 15.00 555.00 0.00
H 0 3.00 225.00 0.00
T 0 1267.50 24519.63 24519.63
189 1829.00 48331.00 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 218 4393.75 82697.94 33183.44
Center 06
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 3 1226.25 8814.11 8814.11
D 0 0.00 0.00 0.00
S 0 15.00 555.00 0.00
H 0 3.00 225.00 0.00
T 0 1267.50 24519.63 24519.63
469 2225.75 61479.22 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 472 4838.50 95996.46 33333.74
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 210 2630.00 18591.61 18591.61
D 0 0.00 0.00 0.00
S 2 15.75 582.75 0.00
H 0 3.00 225.00 0.00
T 0 1267.50 24519.63 24519.63
380 2888.00 72323.72 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 592 6905.25 116646.21 43111.24
Center 09
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 219 3321.25 34198.86 34198.86
D 0 0.00 0.00 0.00
S 0 15.75 582.75 0.00
H 0 3.00 225.00 0.00
T 76 2236.25 30402.63 30402.63
285 3146.25 81843.97 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 580 8823.50 147656.71 64601.49
Center 10
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 10 3331.25 34358.66 34358.66
D 4 8.00 505.00 505.00
S 0 15.75 582.75 0.00
H 0 3.00 225.00 0.00
T 0 2236.25 30402.63 30402.63
567 3750.50 107457.72 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 581 9445.75 173935.26 65266.29
Center 51
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 30 4240.25 35531.16 35531.16
D 9 16.75 828.75 505.00
S 0 15.75 582.75 0.00
H 0 3.00 225.00 0.00
T 0 2236.25 30402.63 30402.63
194 3887.75 112527.72 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 233 10500.75 180501.51 66438.79
Center 52
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 4240.25 35531.16 35531.16
D 0 16.75 828.75 505.00
S 0 15.75 582.75 0.00
H 0 3.00 225.00 0.00
T 11 2313.50 30835.04 30835.04
297 5038.25 119598.22 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 308 11728.50 188004.42 66871.20
Center 53
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 77 4538.75 39231.66 39231.66
D 0 16.75 828.75 505.00
S 0 15.75 582.75 0.00
H 72 130.25 2882.25 2657.25
T 0 2313.50 30835.04 30835.04
70 5343.25 125553.47 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 219 12459.25 200317.42 73228.95
Center 54
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 120 6587.25 45129.26 45129.26
D 0 16.75 828.75 505.00
S 0 15.75 582.75 0.00
H 0 130.25 2882.25 2657.25
T 0 2313.50 30835.04 30835.04
603 6727.50 144032.27 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 723 15892.00 224693.82 79126.55
Center 55
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 19 6621.75 47599.76 47599.76
D 0 16.75 828.75 505.00
S 0 15.75 582.75 0.00
H 0 130.25 2882.25 2657.25
T 0 2313.50 30835.04 30835.04
180 6878.50 148844.27 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 199 16077.50 231976.32 81597.05
Center 57
Flag Claims Units Chgs Paid
-------------------------------------------------
R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 6621.75 47599.76 47599.76
D 0 16.75 828.75 505.00
S 0 15.75 582.75 0.00
H 0 130.25 2882.25 2657.25
T 0 2313.50 30835.04 30835.04
166 7050.75 154325.02 0.00
Other 0 101.00 403.50 0.00
-------------------------------------------------
Total 166 16249.75 237457.07 81597.05